I recently had the chance to chat with therapist Michelle Nietert on an episode of Your Hope Filled Perspective about the increased incidence in mental health issues, including depression in children and teens. If you missed that episode, you can listen in here [Childhood Depression: What Does it Look Like and How Can Parents Help – Episode 95]. Understanding depression in children and teens is such an important topic that I knew we needed to devote at least one blog post to it in order to help educate and equip parents whose children and teens might be suffering from depression.
In many circles there exists a myth that childhood depression doesn’t exist, but that simply isn’t the truth. Although it may be more common for adolescents to experience depression, children as young as 3 years old can have depression. When I first began my career in neuropsychology, I rarely saw depressed children unless they had experienced a traumatic life event (like loss of a parent, or been given a severe medical diagnosis), but over the past three decades I’ve seen the incidence of childhood and teen depression rise significantly.
Childhood depression is different from the normal “blues” and everyday emotions that occur as a child develops. Just because a child seems sad doesn’t necessarily mean he or she has significant depression. If the sadness becomes persistent, or if disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life develops, it may indicate that he or she has a depressive illness and treatment may be appropriate and necessary. Keep in mind that while depression is a serious illness, it is also a treatable one.
What is Depression?
To clear up any misconception, depression is a medical illness, just like heart disease or diabetes.
Here are some facts about depression:
- Depression involves a persistent experience of sad or irritable mood and the loss of interest or pleasure in activities
- It’s more than just feeling blue or having a bad day or bad few days
- Depression is different from feelings of grief or sorrow following a major loss, although for some, grief can at times become depression over time
- Depression is not a personal weakness or a character flaw
- Someone cannot be expected to just snap out of depression.
- Depression is a form of mental illness that affects the whole body
- Depression impacts the way one feels, thinks and acts
- If left untreated, depression can lead to school failure, alcohol or drug use, and even suicide.
Symptoms of Depression in Children and Teens
It’s important to know that no two people with depression will present with exactly the same symptoms or severity, just like two people with allergies can present with different symptoms. That being said, there are many common signs and symptoms of depression in children and teens:
I. EMOTIONAL SYMPTOMS
- Sadness, crying, or mood swings
- Persistent boredom or withdrawal/decreased interest in friends & favorite activities (Anhedonia)
- Hopelessness and helplessness (“I can’t do anything right,” “it’s just the way it is”)
- Anxiety, tension, panicky
- Worry, irritability, brooding, anger
II. COGNITIVE SYMPTOMS
- Negative, self-defeating thoughts (may perpetuate the problems & be resistant to encouragement)
- Difficulty organizing thoughts
- Difficulty concentrating or low energy
- Difficulty completing tasks
- Pessimistic view
- Feelings of worthlessness, guilt, low self-esteem
- Feelings of isolation
- Suicidal thoughts
III. PHYSICAL SYMPTOMS
- Difficulty sleeping
- Change in eating habits or weight
- Agitation, restlessness, or difficulty sitting still
- Frequent complaints of physical illnesses (headaches, stomachaches)
IV. BEHAVIORAL SYMPTOMS
- Avoidance and withdrawal from everyday or enjoyable activities (the bedroom may become a favorite place to escape and find solitude)
- May become clinging and demanding
- May engage in some activities to excess (eating, video games)
- Change in grades
- Getting into trouble at school, or refusing to go to school
- Efforts to run away from home
- Talk of death or suicide
Not all children have all of these symptoms. In fact, most will display different symptoms at different times and in different settings. Although some children may continue to function reasonably well in structured environments, most kids with significant depression will suffer a noticeable change in social activities, loss of interest in school and poor academic performance, or a change in appearance.
Although relatively rare in youth under the age of twelve, young children do attempt suicide — and may do so impulsively when they are upset or angry. Girls are more likely to attempt suicide, but boys are more likely to succeed in killing themselves when they make an attempt. Children with a family history of violence, alcohol abuse, or physical or sexual abuse are at greater risk for suicide, as are those with depressive symptoms.
The Difference Between Normal Childhood Behavior and Depression
Parents are not clinicians, and it can be difficult to know when they are noticing normal childhood behavior as opposed to depression, but there are some general considerations:
- Children become sad about many things. Try to identify what your child is sad about and provide support. If the sadness disappears within a week or two, it is probably not related to depression. Depressed children, however, may have a general sadness about their life and future or not be able to identify why they are sad, and may tear up frequently for no apparent reason.
- Children will normally begin spending more time with their peers and less time with their family. Depressed children, however, may drastically pull away from friends, family and others who they were once close to. They tend to keep to themselves and avoid interactions all together.
- It’s normal for children to lose interest in things they once loved like certain toys or tv shows or activities such as their sports involvement. But depressed children have a hard time finding joy or excitement in anything. They may seem indifferent about many things and not seem to care about what they do.
- Every child feels misunderstood from time to time. A depressed child may feel like no one can understand their feelings, or it’s pointless to try to talk about them. They may fear trying new things, speaking their mind, or sharing ideas for fear they will be rejected, misinterpreted, or ridiculed.
- Children may have academic highs and lows over time or during transition periods. Depressed children may experience a significant decline in grades because they stop doing their work or participating, miss school, or aren’t paying attention. This may be more obvious in a previous high achiever.
- Everyone experiences fluctuations in energy. A depressed child may always seem to lack energy and motivation for almost anything. Even after appropriate sleep, they complain of being tired.
Incidence of Depression in Children and Teens
Many believe that few if any children suffer from depression, but the research suggests that approximately 1 in every 33 children (if not more) have depression. Depression tends to be significantly more common in boys under the age of 10, but by the age 16, girls have a greater incidence of depression. In the teen years, the rate rises to one in eight. The numbers of children/teens who suffer tend to increase if other family members have suffered: 25% of kids who have a parent who has suffered from clinical depression will experience their own episode. If both parents suffered, the risk increases to 75%.
While these statistics are difficult to take in, it’s important to know. Many wonder “what do children have to become depressed about?” There are significant factors which put children at risk so let’s discuss that for a moment:
Risk Factors For Childhood Depression
- Children become depressed because of stressful life events (severe illness, death of a loved one).
- Or if they do not feel successful academically or socially at school
- Kids experiencing family problems (divorce, domestic violence, substance abuse)
- Kids who feel “different” because of their appearance or interests
- Kids suffering from a learning disorder or academic failure
- Genetic predisposition (kids with 1st degree relatives are 2-4x more likely to be at risk)
*Although some kids may be at higher risk, ANY child can experience depression
How Is Depression Diagnosed In Children?
As a parent or loved one, it’s important not to try to self-diagnose your child. Your job is to love them and leave the diagnosis up to the experts. First, before you jump to any conclusions, it’s often quite helpful to have a full medical physical done on the child to rule out any underlying medical conditions. Frequently, medical conditions can cause some symptoms that overlap with depression.
Once a medical condition is ruled out, then you can seek the help and guidance of a mental health professional like a board-certified clinical neuropsychologist who is trained in the diagnosis and treatment of mental health disorders.
A mental health evaluation may include an interview with the parents, information from teachers, psychological testing, laboratory tests and consultation with other specialists. If a diagnosis of depression is made, a comprehensive treatment plan may include psychotherapy, ongoing evaluation and monitoring, and sometimes psychiatric medication.
Typical Treatment of Depression
Depression is a very treatable condition, and in most cases, individuals experience relief within 3-12 months of when treatment is started.
Psychotherapy/Counseling is really talk therapy to work through negative feelings and is a very effective means of treating depression.
Another typical treatment of depression is pharmacology (medication such as Prozac/fluoxetine). It’s important to know that ALL medications come with risks for side effects. Antidepressants carry a risk for increased suicidal ideation—in part because those who are depressed are at an increased risk of suicide because they are depressed. Because of this risk, it is important to consider counseling and medication simultaneously.
Typically, psychotherapy is the first line defense, and then medication may be considered if there is a lack of improvement. The best studies indicate that a combination of psychotherapy and medication is the most effective treatment for depression.
Additional Information To Keep In Mind
The first episode of depression in children is occurring at younger ages than previously recorded. Once someone has experienced a clinically significant case of depression, the chance that they will experience depression again some other time in their life increases significantly.
It’s important to understand and recognize that depression may occur at the same time as other physical illnesses (which is referred to as co-morbidity in medicine). Children who suffer from conditions such as attention deficit hyperactivity disorder, learning disabilities, autism, etc. are at an increased likelihood of also experiencing depression and/or anxiety. Because depression may precede more serious mental illness later in life, diagnosis, early treatment and close monitoring are crucial.
What Can Parents Do?
It really goes beyond saying, but the best thing a parent can do is provide unconditional love to their depressed child or teen. One of the things I recommended most to parents of depressed children was to be that “safe place for them to fall.” Our children and teens are under increased pressure these days and face increased pressures from sources (like the internet) that we didn’t have to contend with growing up.
It’s important for parents and other relatives to know the warning signs of depression in children and teens. If they notice any such symptoms, they should pay attention to duration of symptoms. Take your child to a pediatrician to rule out a medical condition that may appear like depression (i.e. rule out diabetes, anemia, mononucleosis, strep infection). If the symptoms have lasted longer than two weeks, make an appointment to see a mental health professional for evaluation.
Provide your child with opportunities to feel supported and loved. Talk about their daily experiences together, including how they felt, and their reaction to situations they experienced. Also give your child the opportunity to talk and hang out with other supportive adults.
*If your child asks for help…get it! Not doing so sends the message there is something to be ashamed of and may result in years of damage to be undone in adulthood.
*As a parent, you are in the perfect position to help firmly ground your children’s identity in Christ as a safeguard against depression! It’s also important to teach your children the truth about what God says about them:
- You are a child of God and highly valued (John 1:12)
- You are beautiful (Psalm 45:11)
- You are an overcomer (Romans 8:37)
- You are a masterpiece and you are destined for greatness (Ephesians 2:10)
- You are forever loved (Jeremiah 31:3)
- You are wonderful (Psalm 139:14)
- You are worth it (John 3:16)
While much information overlaps significantly between childhood depression, and teen depression, we will be discussing the specifics of teen depression in the next blog post. Additional important information regarding depression can be found in my award-winning books Hope Prevails: Insights From a Doctor’s Personal Journey Through Depression and the companion Hope Prevails Bible Study.